Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: A multisite, single-blind, randomized, controlled clinical trial

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 64; no. 1; pp. 297 - 305
• Main Authors: Kashikar-Zuck, Susmita, Ting, Tracy V., Arnold, Lesley M., Bean, Judy, Powers, Scott W., Graham, T. Brent, Passo, Murray H., Schikler, Kenneth N., Hashkes, Philip J., Spalding, Steven, Lynch-Jordan, Anne M., Banez, Gerard, Richards, Margaret M., Lovell, Daniel J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-01-2012; Wiley; Wiley Subscription Services, Inc
• Subjects: Adolescent; Biological and medical sciences; Child; Chronic Pain - complications; Chronic Pain - diagnosis; Chronic Pain - therapy; Clinical trials; Cognitive Therapy - methods; Confidence intervals; Depression - complications; Depression - diagnosis; Depression - therapy; Disability Evaluation; Diseases of the osteoarticular system; Female; Fibromyalgia; Fibromyalgia - complications; Fibromyalgia - diagnosis; Fibromyalgia - therapy; Health Status; Humans; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Pain; Pain Measurement; Pain Threshold; Palpation; Quality of Life; Teenagers; Treatment Outcome; Human; Striated muscle disease; Chronic; Cognitive therapy; Pain; Treatment; Diseases of the osteoarticular system; Adolescent; Rheumatology; Fibromyalgia; Clinical trial
• ISSN: 0004-3591; 2326-5191; 1529-0131; 2326-5205
• DOI: 10.1002/art.30644

Objective
Juvenile fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence‐based treatments. The objective of this multisite, single‐blind, randomized clinical trial was to test whether cognitive–behavioral therapy (CBT) was superior to fibromyalgia (FM) education in reducing functional disability, pain, and symptoms of depression in juvenile FMS.
Methods
Participants were 114 adolescents (ages 11–18 years) with juvenile FMS. After receiving stable medications for 8 weeks, patients were randomized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions. Assessments were conducted at baseline, immediately following the 8‐week treatment phase, and at 6‐month followup.
Results
The majority of patients (87.7%) completed the trial per protocol. Intent‐to‐treat analyses showed that patients in both groups had significant reductions in functional disability, pain, and symptoms of depression at the end of the study, and CBT was significantly superior to FM education in reducing the primary outcome of functional disability (mean baseline to end‐of‐treatment difference between groups 5.39 [95% confidence interval 1.57, 9.22]). Reduction in symptoms of depression was clinically significant for both groups, with mean scores in the range of normal/nondepressed by the end of the study. Reduction in pain was not clinically significant for either group (<30% decrease in pain). There were no study‐related adverse events.
Conclusion
In this controlled trial, CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS.